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Abstract

Background: Among patients presenting with acute myocardial infarction (AMI), 30% are age 75 years or older. The Thrombolysis In Myocardial Infarction (TIMI) Risk Score is a commonly used, well-validated instrument developed to estimate mortality risk for patients with AMI. However, the TIMI risk stratification model was not specifically developed for older adults (≥75 years). Little is known about physicians’ perceptions of the value of the TIMI risk score in older AMI patients.

Purpose: To describe physicians’ perceptions regarding the strengths and weaknesses of the TIMI Risk Score in older adults hospitalized with AMI.

Methods: This study was part of the “Comprehensive Evaluation of Risk Factors in Older Patients with AMI” (“SILVER-AMI”, R01HL115295-01, PI Chaudhry), a multi-center, observational study designed to develop and validate a risk stratification model for older adults with AMI. This qualitative study included semi-structured telephone interviews with cardiologists and hospitalist physicians who care for older adults with AMI. The constant comparative method was used for analysis with results grouped by emergent themes.

Results: Twenty-two physicians completed interviews ranging from 10-30 minutes (mean = 18 minutes). The mean age of the sample was 41 years, with an average of 16 years of experience after medical school. Reported strengths of the TIMI Risk Score included its ubiquitous presence among medical professionals, ease of use, and utility in guiding clinical management for general AMI populations. Perceived weaknesses included a lack of specific risk factors relevant to older adults, limited capacity for influencing clinical management beyond initial AMI care, and the inability to predict outcomes important for clinical decision-making in older adults with AMI (See Table).

Conclusions & Implications: Physician respondents perceive the TIMI Risk Score as ill-suited for older adults with AMI because it neither incorporates risk factors nor predicts outcomes important for clinical decision-making post-AMI in this population. These results suggest that a new risk stratification model is needed that is better targeted towards older adults with AMI and can more thoroughly assess risk to guide treatment after AMI in this population.